We All Fear Rejection

By the time human organs had been transplanted, many hundreds of operations involving various animals had been performed around the world to test surgical procedures (correctly, many of these experiments would be outlawed by ethics policies today).

Kidney transplants from one human to another had already been hugely successful as a result of these experiments.

The big battle in a heart transplant was not going to be in placing a new heart in a human heart, said Prof Chris Barnard of the heart transplant procedure he perfected for the first time on December 3, 1967. The big battle was getting the heart to stay there and not be rejected by the body or infected.

Rejection of the heart as a foreign object by the recipient’s immune system was a critical barrier to successful transplantation and, in the period leading up to the heart transplant performed on Louis Washkansky. This was largely due to the inadequacy of drugs which could suppress the body’s natural immune system’s response to rejecting the new heart through white blood cells known as lymphocytes.

Barnard spent time studying American methods of controlling rejection. But even after the success of 1967, it would be many more years before a drug was developed which could properly limit rejection of a donor heart. Heart transplant units around the world were active in transplant procedures, but most recipients failed to survive anything but a short period post-op, and this was almost always related to rejection of the new organ. It had negative effects both on the willingness of cardiac surgeons to continue the experimental operations as well as public support for the procedures.

The miracle anti-rejection or immunosuppressant drug was Cyclosporin, discovered in 1971 but only introduced into medical treatment in 1984.

Many thousands of heart transplants later, management of rejection remains the most critical challenge post-operation. It is my daily challenge too and will always be so. And Cyclosporin remains the most important post-operation medication for transplant patients, although of course there is no guarantee that rejection won’t set in. Most transplant recipients experience rejection especially in the early post-operative period.

Currently, I take dosages of cyclosporin in the morning and evening. The dosage is titrated on a regular basis – currently every two weeks in my case – until my body and H2 settle into a rhythm of how much medication is needed to manage the threat of rejection.